Nurse Practitioner GS-0610-12

Enter your Social Security Number in the space indicated. Your Social Security Number is requested under the authority of Executive Order 9397 to uniquely identify your records from those of other applicants who may have the same name. As allowed by law or Presidential directive, your Social Security Number is used to seek information about you from employers, schools, banks and others who may know you. Providing your Social Security Number is voluntary, however we can not process your application without it.

Vacancy Identification Number

Vacancy Identification Number: 795204

Announcement Number: IHS-13-NA-795204-ESEP/MP

1. Title of Job

Nurse Practitioner GS-0610-122. Biographic Data

3. E-Mail Address

4. Work Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

5. Employment Availability

6. Citizenship

Are you a citizen of the United States?7. Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

8. Other Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

9. Languages

If you are applying by the OPM Form 1203-FX, leave this section blank.

10. Lowest Grade

Enter the lowest grade level that you will accept for this position. The lowest grade for this position is 12.

12

11. Miscellaneous Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

12. Special Knowledge

If you are applying by the OPM Form 1203-FX, leave this section blank.

13. Test Location

If you are applying by the OPM Form 1203-FX, leave this section blank.

14. Veteran Preference Claim

15. Dates of Active Duty - Military Service

16. Availability Date

17. Service Computation Date

If you are applying by the OPM Form 1203-FX, leave this section blank.

18. Other Date Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

19. Job Preference

If you are applying by the OPM Form 1203-FX, leave this section blank.

20. Occupational Specialties

Select/enter at least one occupational specialty. The specialty code for this position is001 Nurse Practitioner

21. Geographic Availability

Select/enter at least one geographic location in which you are interested and will accept employment. The location code for this position is:

236450003 Presque Isle, ME

22. Transition Assistance Plan

23. Job Related Experience

If you are applying by the OPM Form 1203-FX, leave this section blank.

24. Personal Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

25. Occupational/Assessment Questions:

1. Are you a United States Citizen or National, who is at least 16 years old?

A. YesB. No

The following section is used to determine your eligibility for appointment under the Merit Promotion or Excepted Service Examining Plan in the Indian Health Service. Please respond "Yes" or "No" to the following statements. Do not leave any section blank. NOTE: You must submit the required documentation to verify your eligibility as indicated below. Failure to provide the required documents will render you not eligible for consideration. See instructions under the "How to Apply" tab for submitting documentation.

The following section is used to determine your eligibility for appointment under the Merit Promotion or Excepted Service Examining Plan in the Indian Health Service. Please respond "Yes" or "No" to the following statements. Do not leave any section blank.

A- Yes.B- No.

2. Are you a current, permanent (non-temporary) civilian employee on a competitive service appointment in a Federal agency or a former civilian Federal employee who achieved career status in the competitive service; or an interchange agreement eligible; or a VEOA eligible; or a former civilian Federal employee who served on a career-conditional appointment and was separated less than three years ago without achieving career status in the competitive service? (You must submit supporting documentation).

3. Are you eligible for Indian preference as defined by the Department of the Interior (DOI) and as evidenced by appropriate Bureau of Indian Affairs (BIA) authorized certification? (You must submit a properly completed and signed copy of the Bureau of Indian Affairs (BIA) Form BIA-4432, "Verification of Indian Preference for Employment in the Bureau of Indian Affairs and the Indian Health Service," for employees claiming Indian preference.)

4. Are you an Indian Health Service scholarship recipient who has completed the necessary requirements for an approved health profession degree in accordance with your academic institution and under the Indian Health Care Improvement Act (IHCIA)? (You will receive highest priority placement consideration for available vacancies within the IHS).

5. Have you held a permanent position in the competitive service at the same grade level with the same or higher promotion potential as this position; or be an Interagency Career Transition Program (ICTAP) applicant; or be eligible for a special appointment authority such as a Schedule A for the severely disabled? (You must submit supporting documentation).

6. Are you interested in performing the duties of this position within the United States Public Health Service Commissioned Corps? (You must submit sufficient information to permit this office to determine whether you meet the qualification requirements, including any selective placement factor).

INSTRUCTIONS: The following section is used to determine your Method of Consideration/Referral.

7. Please indicate which of the following plans you want to be considered under: you will only be considered for those that you indicate and are within reach for referral. Do not leave this section blank.NOTE: You must also submit the required documentation to verify your eligibility as indicated in the vacancy announcement. Failure to provide the required documents will render you not eligible for consideration.

A. I would like to be considered for Merit Promotion Plan (MP)B. I would like to be considered for Excepted Service Examining Plan (ESEP)
C. I would like to be considered for both A and B (MP/ESEP) D. I would like to be considered under the Commissioned Corps Personnel SystemE. None of the above hiring plans apply to me

1. In order to qualify for this position, you must meet the Basic Requirements for a nurse position. Select the response that most closely and accurately describes your background which demonstrates how you meet the education and registration requirements. Select only one response and do not leave blank.

A. I have successfully completed a degree or diploma from a professional nursing program which was approved by the legally designated State accrediting agency at the time my program was completed. In addition, I have an active, current registration as a professional nurse in a State, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States. (Must submit transcripts and current registration)B. I graduated from an approved nursing educational program as shown in "A" above in the past 12 months and expect to receive State registration as a professional nurse within the next 6 months. (Must submit transcripts and current registration)C. I have completed undergraduate course work in nursing; behavioral, physical, or biological sciences related to nursing; nutrition; public health. I do not have an active, current registration as a professional nurse, nor do I expect to receive registration within the next 6 months. (Must submit transcripts)D. I am currently in an approved Nursing degree program and expect to graduate within 9 months as shown in "A" above.E. I do not have the education and/or experience as described in the above statements.

2. GS-12: From the descriptions below, select the response that best describes your experience which demonstrates your ability to perform the work of this position at the GS-12.

A. One year of specialized experience equivalent to at least the GS-11 level as described in the vacancy announcement.B. I do not meet the experience or training as described above.

This position requires a nursing license before entering on duty.

3. I will have a current, valid, active, unrestricted license in any State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States before entering on duty?

A. YesB. No

For each of the following task statements, select one response below (A-E) that best describes your experience level.

A- I have no experience in performing this task.B- I have limited experience in performing this task. I have had exposure to this task but would require additional guidance, instruction, or experience to perform it at a proficient level.C- I have experience performing this task across routine or predictable situations with minimal supervision or guidance.D- I have performed this task independently across a wide range of situations. I seek guidance in carrying out this task only in unusually complex situations.E- I am considered an expert in carrying out this task. I advise and instruct others in carrying out this task on a regular basis. I am consulted by my colleagues and/or superiors to carry out this work behavior in unusually complex situations.

4. Conduct assessment on patients' needs in accordance with standards of care and the nursing process.

5. Provide emergency treatment to stabilize and transport patients.

6. Participate in initiating revisions in the standing orders and/or certification when credentials show additional competencies.

15. Provide comprehensive nursing care to patients based on the physicians' medical care plan and the physical, mental and emotional needs of the patient.

16. Serve as a primary health advisor to the community and tribal groups and officials.

17. Provide individual and family counseling, guidance and health instructions related to preventing diseases and maintain good physical and mental health.

18. Conduct in service classes for other health care workers on specific topics related to nursing.

SECTION II. CERTIFICATION OF INFORMATION ACCURACY

As previously explained, your responses in this Assessment Questionnaire are subject to evaluation and verification. Later steps in the selection process are specifically designed to verify your responses. Deliberate attempts to falsify information will be grounds for disqualifying you or for dismissing you from employment following acceptance. Please take this opportunity to review your responses to ensure their accuracy.

Certification of Information Accuracy If you fail to answer this question, you will be disqualified from consideration for this position.

19. I certify that, to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C. 1001); my eligibilities may be cancelled, I may be denied an appointment, or I may be removed and debarred from Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated. I understand that responding "No" to this item will result in my not being considered for this position.

A. Yes, I certify that the information provided in this questionnaire is true, correct and provided in good faith, and I understand the information provided above.B. No, I do not certify/understand the information provided above.